Monday, February 27, 2012

Dentist vs. Physician

Let’s talk about the timeless age old debate. Which came first - the chicken or the egg? No, the real debate: is a dentist a doctor or is a physician the only real doctor? I think maybe the only other health care doctor other than a dentist that takes more of a beating is the chiropractor (as Rodney Dangerfield stated, “I get no respect!”). If you read my blog last week, I ended it telling you to go to YouTube, look up Dentist vs. Doctor, and watch the extra normal video.

My wife works at a hospital as an RN part time. She has commented that when people hear her mention Dr. Joyce, they ask what type of doctor he is. When she responds they say, “Oh, he is just a dentist!” This will make more sense if you watch that video. It appears from the comments that some physicians and dentists take this issue very seriously.

We have all sorts of doctorate degrees: PhD, PharmD, DMD, DDS, MD and so on. Each of them specify or indicate an advanced level of education and knowledge that come with the title. By no means do I think or feel I am a physician. I have a Doctor of Dental Medicine degree. I spent 4 years after undergraduate and then another two years of formal accredited education learning about the diseases and conditions that are associated with the oral cavity, head and neck. When I sit back and think about it, what I find amazing that not only do I examine and diagnose, but also perform surgery if needed (removing and repairing living human tissue), sometimes all in the same hour. Someone has to be well-trained and knowledgeable to do that and cause no long-term ill effects. For that accomplishment, one is worthy of the title Doctor!

How many times have you heard about someone going to their internist or general family practitioner with a suspicious looking mole and having it removed and biopsied. This is almost never done anymore. Sorry Michael J. Fox, but Doc Hollywood delivering babies and setting a fractured arm in the same day just doesn’t happen. (I used this reference because the town they filmed that movie in is just up the road from me.) It is an instant referral to the dermatologist and you know the rest.

Most of the physicians that I know understand and respect what we do. They know they need us and we need them! I think most of this inaccurate perception is from the general public. We are just dentists and you can pick one up at any Saturday morning garage sale. I guess this all started back in history with dentistry springing off from barbers. It has been the scarlet letter we have had to bare for many years. Being the redheaded step child of the medical/dental community has its advantages. When it comes to health care overhaul, dentistry has stayed out of the spot light. We have had to deal with insurances, but dentistry has still been able to operate as more of a small business model with not as much government regulation.

This issue has lead into the reality of compensation. I cannot quote or verify this info, but the last reports that I saw had the general dentist making considerably more money than a general family practitioner. I think a lot has to do again with government infringement on medicine and insurance dictating fees. Private practice medical doctors have a business to run and profit margins. Many MDs that I know have to see sometimes hundreds of patients a day to pay the bills.

Have you heard that dentists do not save lives but real doctors do? I have, on numerous occasions, drained a space infection that left untreated would have killed someone. This happens in third world countries, but not in our society due to the care. Dentists know that typically when a patient shows up to the E.R., it is usually a six hour wait and a Rx for an antibiotic and an analgesic, and they are told to go find a dentist. How many times does a podiatrist or psychiatrist directly save a life? Most physicians besides surgeons, oncologists or emergency room physicians probably directly save lives. All the rest are just like dentists.

I did not want the responsibility of having to be tied to a pager or on call for the hospital rushing out at 2 a.m. for an emergency. I know not all physicians have this lifestyle and dentists do have emergencies. I like the fact that I am out every day at 4 or 5 p.m. and go work out or hang out with my family. Dentistry can be very stressful, but quality of life is important.

I heard the jokes in dental school. Dentists are just dropout medical students that could not hack it! I never applied to medical school and only know one person in my class of 70 or so that was a flunked-out med student. I actually know some that dropped out of dental school and went to med school because they did not have the hand/eye dexterity. Imagine trying to carve a precise 5mm x 5mm x 5mm deep box in the side of an object in a dark wet hole and while looking in a mirror with an object that occasionally moves and makes unpleasant sounds. Sounds easy, right?

I think young people are starting to figure out some of these details. I attend a presentation yearly for the University of Florida, College of Dentistry that talks about admission statistics. The number and quality of applicants has been going through the roof the last ten years and it has become ultra competitive. They have a 4.0 GPA, they volunteer , etc… Many of these students could probably go to any medical school they wanted but chose dentistry as a career choice. This should tell you something.

We could go on more about this subject, but I feel this is mainly a misconception from the public about who we are and what we do (not from physicians). Some physicians may think and act like dentists are second-class citizens in the health care world, but for the most part, they appreciate us. I also know some dentists that think they are physicians and walk around like they are doing brain surgery every day. Dentists and physicians are different animals, but both worthy of the title of Doctor. Most physicians I believe value and respect us and want a dentist on the front line of battle with them. I feel the same.

16 comments:

Dr. Andy
said...

Actually, Dentistry was the first recognized specialty within Medicine. (Wow, that dental history lecture finally paid off.)

You are right about physicians respecting us. I've been sent to the ER room twice in my life. Both times each physician (ER plus other specialists) always referred to me as Dr. They'd say, "How are you feeling Dr.?"

The difference is night and day . Read Maggie Kozel's book , 'The Color of the Atmoshere '. She was a pediatrician with the Navy and has private practice experience . They save lives daily , not once in awhile . They are on call and spend nights in the hospital ( often) with sick patients . 70 hours a week of pt. care is the norm and they 'earn' less than we dentists.

Just don't worry about it.If you want to be a dentist be the best you can be or get out. I have a large number of medical doctor patients- they just want me to do a good job and not hurt them, no airs , no graces, just an expectation that I'll care for them the way a good dentist should. I expect the same from them. They also refer their own patients to me- that's accolade enough.

I have to agree with the previous comments. I'm a dentist who works in a hospital and I have nothing but respect for my physician colleagues, and I feel the same sentiment returned from them. They do make a greater sacrifice, and have life and death situations everyday. My sister in law is a heme/onc physician who had two of her patients unexpectedly pass away last week despite everyone's best efforts. Look, this is America, if we wanted to be physicians, chances are, those of us who have the ability to be dentists could have done so if we chose. We chose to be dentists for whatever reason. And I think what you're expressing may be some kind of insecurity that some of us may feel at times about our decision. I'm sure a lot of people feel that way no matter what field they're in. Generally, I think if you have respect for the rest of the medical community, do the best you can, and treat people fairly and kindly and it will be returned to you.

Wow. What a frivolous turf war. And I'm pretty sure it started with the physicians' insecurities with the doctor title.

Physicians as we know are doctors of medicine. I am a doctor of dental medicine. It's a difference in semantics and colloquialisms that has forever become firmly lodged in our zeitgeist. We will never get rid of this confusion -ever - and Joe Patient will never understand it so we must bear with and accept this perpetual confusion. It's like Kleenex versus facial tissue.

When speaking with patients, I refer to MDs as physicians. Half of the time people will ask what a physician is and then I remind them that he is their medical doctor. It's a light bulb moment most of the time when they realize that we're both doctors, but of different things. I think given the current high level of dental medicine, if history had a do-over, we'd be called Stomatologists - medical specialists of the mouth and jaws. Think about it. I mean nobody under 70 goes to a barber these days, they go to a hair stylist. It's not apples and oranges. It's titles and nouns. People use the nouns right, they just get confused with the titles. G in BC.

Most Med (MD) students think that all othernon-physician healthcare doctorates are people who couldn't get in med school. We all know that isn't true. Many others did get accepted but chosen their field based not on percieved prestige or potential $$$ income. I know a great physician MD who was a german language major who went to europe after her BA. And then needed ajob and went to work for a lab, then decided tobecome a doctor and took a few more science classes took mcat and got in a decent school. My roomate who got courted by our med school had a 3.973 GPA and whas a Chem Major with a Bio minor in honors college could of easily got in with me at med school, but chose PharmD route and loves it (that's whats important). I could of never got into the PharmD program, I was a bio major with a 3.54, hated chem (esp. organic chem). the average PharmD gpa at our school was 3.83plus they had to take higher level science prereqs. Ask any of us MDs 5 years out of school or resi. and ask how much superior we are than a DDS when we have a mind splitting tooth ache. Tell them that just before you get yourshot or go under --dare ya. lol. Noboidy laughs at God in the hospital or in the dental chair-ala Regina Spektor song. Most of us don't need to hear doctor, infact I hear Superintendents and public school admins demand to be addressed doctors, if I was having a heat attack could they help? Maybe. But an EMS tech, RN, PA,DPM, DDS, MD could for sure. All fields have errogant A**holes, and I admit many of my colleages do. I appreciate anyone who is good at their craft and if you are good , you shouldn't have to feel insecure that you have to feel superior to another,because in other aspects yopu are not, there is always someone better at something else than you are. Just ask the ex-wife of the hot shot surgeon.

To the person talking about Superintendents and administrators: for teachers and professors or even MD's, DMD's or anyone else, they all have doctorate degrees and they all have worked really hard for it. Being a "doctor" doesn't mean you save lives, it means that they have worked hard for their education and get a title saying so. A Doctorate is a degree indicating that you've achieved the highest possible level of education you can get in your field. Power to them! .....and it's our responsibility to give credit and respect to the people who are educating us.

In my opinion dentistry should be a subspeciality of medicine.Dentists shoud first finish med school and then get a 2-3 years dental speciality since they prescribe drugs ( mostly antibiotics and painkillers) and are involved in minor surgical operations (f or the major operations in the area there are the maxilofacial surgeons which in their majority are physians)I also agree with the opinion that anyone who excels in his field of study and gets a Phd should honorly called doctor.Generally speaking I also have noticed that dentists are getting more money than manny doctors especialy the ones involved in orthodotics and dental implants with significally less stress and less years of studying than Physians do. So let physians at least get the fame :-p lol

Actually, a real doctor is a person who teaches in a university setting. However when doctor is used in a clinical setting one understand physicians. So in this case dentist using the title Doctor is misleading.

" I examine and diagnose, but also perform surgery if needed (removing and repairing living human tissue), sometimes all in the same hour. Someone has to be well-trained and knowledgeable to do that and cause no long-term ill effects. For that accomplishment, one is worthy of the title Doctor! "

Yes, dentists do diagnose and treat but not the same way as a physician can. Dentistry is a healthcare too, yes but it is more restricted. Any specialist doctor can also do general medicine but not dentists.

"How many times have you heard about someone going to their internist or general family practitioner with a suspicious looking mole and having it removed and biopsied."

Actually my mole was removed by a general practitioner. There are a lot of things a general practitioner actually do when needed as well.

"How many times does a podiatrist or psychiatrist directly save a life?"

I don't have the number but they do save lives. And Dentist can save lives too. Paramedics and Nurses save among many other professions save lives. This isn't only about saving lives.

Let's come to respect. First of all, not every specialist get the same respect. For example, a general surgeon or a cardiologist is respected more than a dermatologist. Because, generally, in medicine you have people going extra lengths and sacrifice greater deal of their life than dentists do so they get more respect and they deserve that. If dentists want to have more respect, they can start working extra hours for example so I wouldn't have to wait another week for my aching wisdom tooth to be attended because all the dental appointments are full in a dentist's office who works 4 days a week.

Psychiatrists do save lives, mind you. They treat people who might otherwise suicide. The average psychiatrist probably saved more lives than all dentists in the world combined.

The bottom line is that all doctors save lives but not dentists, so doctors deserve more respect. Dentists have more similarities with a cosmetician than a physician, and they do not deserve the title 'doctor'

What you've just said is completely untrue. I've been a practicing dentist for over 12 years and have detected early stages of ulcers and oral cancer tumours. If patients didn't visit me, those tumours could have become more threatening or spread to other parts of the body. Dentistry is a preventative practice, we prevent deaths. All medical practitioners involved with diagnosing and treating medical conditions are given the title Doctor. All medical practitioner, regardless of field, are respected equally since they work together to improve standards in healthcare and help patients get better in different ways. Dentistry IS more challenging that general or specialist medicine since doctors depend on each other, one diagnoses (usually the GP) then refers, during operations another doctor deals with anaesthetics, one deals with radiology and so forth. Dentists are in charge of completing treatments by themselves, and therefore the role cannot be said to be less challenging. I've met doctors aiming to do Maxfax who felt the BDS course was much harder, in fact a qualified doctor failed his second year. The training is just as hard as well. Get your facts right before you critisise my profession!

Dr. Rakesh, you are wrong about dentisty being more challenging and not depending on doctors. When you detected oral cancer did you treat it yourself or refer it to a medical doctor? See you are dependent on medical doctors too. There are diseases a single medical doctor can diagnose and treat as well.

The hardness on the basic training could be equal on both but you have to do internship and residency in medical training so in the end medical training in general is harder than dental training.

How many times does a podiatrist or psychiatrist directly save a life?

A podiatrist is not an MD. They do not go to medical school. And they do perform surgeries and save lives. I guess feet are on the other end of the body so you don't really know what goes on with them. Diabetic foot disease anyone?

And let me assure you suicide is a lot more common killer of the young in the United States than tooth decay. Go to medical school and work in a psychiatric ward and then tell me psychiatrists don't directly save lives.

And as someone else stated your characterization of procedures is way off. Family practitioners do a lot of stuff in their offices. So do many other specialties. Just because they aren't one trick ponies doesn't mean they don't directly save lives. And there are a lot of procedures they can do but they simply choose not to do because they don't get paid enough. Between low compensation and awful malpractice a lot of stuff is best left to other specialties. But literally with a stroke of the pen all that can change. Anyone that follows medicine knows different procedures practiced by different doctors go through phases based on compensation and malpractice. Are you beginning to see why dentists don't have the same level of prestige as MDs? It's a question of knowing what you don't know. That's the problem in the medical field. So many nondoctors don't know what they don't know. I would never pick up a drill and start drilling into someone's teeth. Neither would any doctor. We know what we don't know and we leave that type of thing up to the pros.

And the problem is in the vernacular in a healthcare setting "doctor" only means one thing... MD. There are some legislative efforts being debated right now that will require everyone in healthcare facilities in certain states to put their TRUE credentials on their badge to be displayed at all times so we can get rid of people running around in white coats calling themselves "doctor." And of course all the nonMDs have been fighting the effort... I wonder why. Imagine we have nurses doing some graduate studies and then running around a hospital in a white coat calling themselves "doctor." Would you allow a nurse to run around your office in a white coat calling herself "doctor" and drilling into people's teeth? Are you beginning to see the problem?

Honestly, these debates are as ridiculous as they are pointless. I can maybe see why nurses running into rooms and calling themselves "doctors" in a hospital setting would be concerning but what does that have to do with dentists? These are professionals who perform surgery, diagnose and prescribe in a region of the body that no MD has skill set to handle ie there isn't the overlap in training which you would find in nurses. If you truly think that your mouth is so unimportant that it doesn't deserve it's own Dr. then I suggest you go a week without using it (no eating, drinking, talking etc). We in the medical community tend to complain based on how much our position requires us to endure. Surgeons, for example, knock dermatologists and anesthesiologists all the time because they have a better lifestyle. Dentists working for themselves have some of the highest incomes I've seen working far less than any of my other physician colleagues which is why we feel comfortable tearing them down every now and then. At the end of the day, the most important specialty is the one you need and yes, I'll be the first to argue against the point brought up by another poster above me that primary care physicians have a more difficult job than general dentists. They both diagnose but only the latter regularly performs surgery requiring hand skills that most primary care physicians (certainly not myself) do not possess. This doesn't make them better than us but just reflects the individual career paths which were chosen. That is all.

I am an oral and maxillofacial surgery resident. We treat all facial fractures including complex reconstructions of pan facial trauma. I do my own bone graft from the hip and take free fibula segments for jaw reconstruction.

Our specialty also treats benign and malignant pathology of both jaws and the ioral cavity. I do my own gland excisions. We also do Orthognathic surgery.

Additionally, I can take out any tooth in your mouth, perform all the pre prosthetic surgery you need, place implants.....the list goes on and on.

In the US our training post dental school is 4-6 additional years of residency. I did 4 months of general surgery, 2 months of internal medicine, 5 months of anesthesia, neurosurgery, ENT, trauma.....I took care of some very sick patients.

I do my own tracheostomies and have intubated 300+ pts.

Unless you have seen an OMS for something other than wisdom teeth or implants, you likely have no idea of what our specialty entails.

Dentists are dental doctors, but not medical doctors. So it is appropriate to call dentists as doctors, not for the reference to medical doctors, but to dental doctors. Some MDs shouldn't feel insecure about the "doctor" title's being used to refer to dentists as long as the title has reference to and nuance of dental doctors.

Dentists, especially those with specialties such as oral and maxillofacial surgery which require 4-6 extra years of training, do save lives. They diagnose and treat oral diseases like oral cancer and life-threatening injuries that require, for example, face and jaw reconstruction.

I hope this debate about the use of the "Doctor" title and its pertinence and prestige would end, because it is a pointless waste of time that reflects misconceptions and people's insecurities about themselves in the medical field.

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